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STI treatment guidelines
| STI | PREFERRED TREATMENT – TREATMENT CONDITIONS | FOLLOW-UP | ||
| RECOMMENDED REGIMEN | PREGNANCY REGIMEN | PENICILLIN ALLERGY | ||
| CHLAMYDIA | Azithromycin 1 g po Stat in single dose if poor compliance is expected OR Doxycycline 100 mg po bid for 7 days ALTERNATIVE Ofloxacin 300 mg po bid for 7 days OR Erythromycin 2 g/day po in divided doses for 7 days OR Erythromycin 1 g/day po in divided doses for 14 days |
Azithromycin 1 g po in a single dose if poor compliance is expected OR Amoxicillin 500 mg po tid for 7 days OR Erythromycin 2 g/day po in divided doses for 7 days OR Erythromycin 1 g/day po in divided doses for 14 days |
Same as recommended treatment regimen. | Test of cure should be performed 3-4 weeks after treatment for all pregnant women and nursing mothers who have used erythromycin or amoxicillin. All other clients only require a 6 month repeat test. |
| GONORRHEA | First Line Therapy: Ceftriaxone 250 mg IM Stat + Azithromycin 1 g po Stat Alternate Therapy to be considered if first line therapy is not available or allergies exist: Cefixime 400 mg po Stat + Azithromycin 1 g po Stat OR Spectinomycin 2 g IM Stat + Azithromycin 1 g po Stat OR Azithromycin 2 g po Stat |
First Line Therapy: Ceftriaxone 250 mg IM Stat + Azithromycin 1 g po Stat Alternate Therapy to be considered if first line therapy is not available or allergies exist: Cefixime 400 mg po Stat + Azithromycin 1 g po Stat OR Spectinomycin 2 g IM Stat + Azithromycin 1 g po Stat OR Azithromycin 2 g po Stat |
Spectinomycin 2 g IM Stat + Azithromycin 1 g po Stat OR Azithromycin 2 g po Stat |
Test of Cure If pharyngeal/rectal infection, pregnancy, potential susceptibility, or potential treatment failure:
If none of the above have occurred, rescreen 6 months post treatment for potential repeat infection |
| PID | Regimen A: Ceftriaxone 250 mg IM in a single dose PLUS doxycycline 100mg po bid for 14 days OR Cefoxitin 2 g IM PLUS probenecid 1 g po in a single dose concurrently once PLUS doxycycline 100 mg po bid for 14 days Many authorities recommend the addition of metronidazole 500 mg po bid for 14 days to this regimen for additional anaerobic coverage and treatment of bacterial vaginosis Regimen B: Ofloxacin 400 mg po bid for 14 days PLUS/MINUS metronidazole 500 mg po bid for 14 days OR Levofloxacin 500 mg po qd PLUS/MINUS metronidazole 500 mg po bid for 14 days |
Pregnant women with suspected PID should be hospitalized for evaluation |
Individuals receiving outpatient therapy should be re-evaluated 2-3 days after treatment has been initiated. If no clinical improvement, hospital admission is required. | |
| EPIDIDYMITIS | Doxycycline 100 mg po bid for 10-14 days PLUS Ceftriaxone 250 mg IM in a single dose OR Ciprofloxacin 500 mg po in a single dose (unless not recommended due to quinolone resistence) |
Azithromycin 2 g PO in a single dose | Retest post treatment if compliance is uncertain or if alternative treatment is used. |
|
| SYPHILIS | Primary, secondary, early latent, less than 1 year duration: Benzathine Penicillin G 2.4 million U IM in a single session Late latent, more than 1 year of indeterminate duration: Benzathine Penicillin G 2.4 million U IM once/week for 3 successive weeks (Call the Sexual Health Clinic to obtain.) |
Primary, secondary, early latent: Benzathine Penicillan G 2.4 million units IM weekly for 1-2 doses There is no satisfactory alternative to penicillin for the treatment of syphilis in pregnancy; strongly consider penicillin desensitization followed by treatment with penicillin Late Latent: Benzathine Penicillin G 2.4 million units IM weekly for 3 doses |
Strongly consider penicillin desensitization. Primary, secondary, early latent: Doxycycline 100 mg po bid for 14 days Ceftriaxone 1 g IV or IM daily for 10 days Late Latent: Doxycycline 100 mg po bid for 28 days Ceftriaxone 1 g IV or IM daily for 10 days |
For primary, secondary and early latent: repeat serology at 1, 3, 6, and 12 months after treatment. For late latent: repeat serology 12 and 24 months after treatment. |
| LGV (Lymphogranuloma venerum) |
Doxycycline 100 mg po bid for 21 days ALTERNATIVE Erythromycin 500 mg po qid for 21 days Possibly, Azithromycin 1 g po once weekly for 3 weeks |
Erythromycin base 500 mg orally 4 times a day x 21 days Azithromycin 1 g orally for 3 weeks (may be effective, but not proven) |
Erythromycin base 500 mg orally four times a day x 21 days (DO NOT use estolate formulation in pregnancy) |
Test of cure should be repeated until tests are negative and patient has recovered. |
Adapted with permission from Niagara Region Public Health Department, Halton Region Health Department and from the 2008 STD (Canadian) Guidelines Updated July 2013.